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Published 10 May 2016
Technology is crucial in almost every part of modern life and healthcare is no exception, with the NHS now using numerous forms of tech. And its potential is only just starting to be realised.
Smart information technology, groundbreaking devices and mobile applications (apps) on smartphones and tablets are now all a part of today’s healthcare provision. Yet the NHS still staggers under the weight of the paperwork it produces, while the quality and capacity of NHS IT still varies from organisation to organisation within the sector.
For its part, the government is keen to promote growing use of technology in the NHS and in February, the Department of Health and National Information Board announced IT expert Professor Bob Wachter has begun a review of computer systems across the NHS.
The review will address issues such as electronic health records, as the NHS aims achieve a paper free health system by 2020, will consider the experiences so far of clinicians and trust leaders with regards to IT, and will examine current capacity and capability of trusts’ IT systems. It is due to report back in June 2016.
Health Secretary Jeremy Hunt said at the time of the review launch: “We must give [NHS staff] and patients the most up-to-date technology – this review will tell us where we need to go further.”
Meanwhile, the first wave of a joint programme called NHS Innovation Test Beds was launched in January.
This collaboration between NHS England, the Office for Life Sciences, the Department of Health and the Department for Culture, Media and Sport is designed to modernise care.
Seven different sites around England will pilot new ways of helping particular patient groups including older patients, people with long-term conditions and people with mental health problems.
The pilots bring together local health bodies including clinical commissioning groups (CCGs), hospital trusts, and primary and community care providers with a range of innovative tech firms to use technology to address some of the most complex issues facing patients and the health service. The tech firms involved include Verily (formerly Google Life Sciences), IBM and Philips.
Frontline health and care workers in the chosen areas will pioneer and evaluate the use of novel combinations of interconnected devices such as wearable monitors, data analysis and ways of working intended to help patients stay well and monitor conditions themselves at home.
For example, under the plans, patients with diabetes will be equipped with remote monitoring and coaching technology to allow them to better self-manage their condition. Older patients who are most at risk of critical health events will be identified using data analysis and then helped to use telecare and remote devices in their homes so healthcare professionals can provide help more quickly when needed.
In addition, people at risk of serious mental illness will be able to use technology and apps to manage their condition, linked to a hub, which can dispatch specialist staff at the right time to help if a crisis looks likely.
There are remarkable opportunities to harness technology in healthcare, as long as the NHS is open to change, says Giles Peel, Head of Governance Advisory Practice at DAC Beachcroft.
“Technology saves time and money in all areas of life,” says Peel. “It’s probably cheaper, it provides better access and undoubtedly there are apps that are starting to make a lot more difference around your access to healthcare advice.
“What you don’t want is the market rapidly becoming unregulated, with all number of people offering services online or by app and you have no idea of what their quality is. The health profession has got to embrace it, lest they lose control of it.”
He goes on: “There are quite a lot of areas where technology has advanced so much that things can be done in a fundamentally different way. There are apps that are staggering in their versatility and importance.”
One such app is Babylon, a UK-based subscription health service registered with the Care Quality Commission (CQC), which for a monthly payment, allows unlimited GP appointments via a smartphone or tablet, access to a user’s electronic records and an ‘Ask’ service for questions by text. Beyond this, paid-for features include specialist consultations, therapy sessions and tests that can be sent to the user’s home.
Meanwhile although physical activity measuring apps are becoming increasingly common, as are devices such as the Apple Watch or Fitbit wristbands, mental health is another area that is benefiting from new technology.
Moodnotes is an app developed by UK-based firm ustwo [sic] as part of a joint venture with US developer Thriveport and launched in August of last year.
This is a mood tracking CBT (cognitive behavioural therapy) and journaling app for people to track their moods and develop healthier thinking habits.
Designed with clinical psychologists, the app is intended to help people become more aware of their moods, help them identify which thinking traps they are falling into and to facilitate an experience that helps them develop more positive thinking habits.
It can be used safely by people who have been diagnosed with or have suspected mental health problems, but is also designed for use by anyone keen on developing healthier thinking habits.
Dem Gerolemou, a product designer for ustwo, is a firm believer in the potential of apps and technology to help improve healthcare.
“Currently we have a lot of lifestyle-type data being recorded that I suspect we are not particularly aware of. Being able to pass this on to healthcare specialists could potentially mean they see things that they may have [otherwise] missed or may not have been able to tell just from a check up. It’s opening up the door to a multi-texturally rich image of our lives through technology.”
Although most of the devices that are recording data are not medically certified, they can help highlight patterns so clinicians can take preventative steps, argues Gerolemou.
“There are very much patient facing applications. An example of that would be something where a patient or user would interact with a certain application to be able to track or record or measure their own health or wellbeing, whether that be mental or physical.
“There are also applications being developed which are much more for healthcare specialists so they help them track patient data and manage their work schedules.”
Capturing data safely and securely through apps is an issue that still causes concern.
Andrew Rankin, Associate at DAC Beachcroft, says: “developers and suppliers of apps need to comply with the requirements of the Data Protection Act 1998, and to that extent apps are no different to the use of any other technology, however complying with legal requirements can present extra challenges where for example a user interface is presented on a small screen, and the user wants immediate convenience”.
There is also an element of age profile that plays a part in this debate, according to Peel.
“There is a generation from about [age] 45 onwards who are very fussy about having their personal details shared, but I think the app generation don’t care as much [about that].
“Generationally, youngsters are instinctively transparent and [more likely to] share. So the technological leaps that are possible with a population that doesn’t mind its details being shared – including medical confidentiality – is a hugely important change. And it is one that I don’t think the regulators, government or the health service have really got their heads around,” adds Peel.
Regular day-to-day telemedicine provided by the NHS may sound like an idea for the future but it is already a reality in the north of England.
A telemedicine service has been running since 2011 from Airedale Hospital in West Yorkshire. It is a 24/7, 365 days per year digital hub that provides care homes with immediate video access to a clinical advice service provided by senior nursing staff supported by clinicians drawn from a range of specialties.
A year ago the project became the Airedale and Partners Enhanced Health in Care Homes Vanguard – one of the NHS’s first 29 ‘Vanguard’ areas that will take the national lead on transforming care for patients in towns, cities and counties across England.
The scheme operates across the three counties of North and West Yorkshire and East Lancashire and aims to improve the care and end of life care of almost 8,000 people living in the 248 nursing and residential care homes across those areas.
The scheme has the support of a range of partners including three acute trusts, three local authorities, two community and mental health providers, more than 130 GP practices and a number of third sector organisations, universities and colleges.
Marking the first anniversary of the scheme’s Vanguard status, Chief Executive of Airedale NHS Foundation Trust Bridget Fletcher says: “We know that our Vanguard is already contributing to reducing emergency activity, by keeping people safe and well in their normal place of residence for longer, and ensuring that as far as possible, the right resources are deployed at the right time to care for people. This enables people to take greater control of their own care.”
Rachel Binks, Nurse Consultant in Digital and Acute Care at the Trust, says that although the project is working well now, it took time to gain momentum.
“It was a very slow start because it was an unproven concept and it’s quite difficult to get some of the data nationally to prove that you have made a difference,” says Binks. “It has proven itself and the Vanguard has helped in not only promoting the service but also in showing what we have been doing over the last five years. I think it [the project] makes a very big difference and in our local area, we have managed to hit our A&E [waiting time] targets which a lot of areas are not managing to do.”
Older people using the service are happy to do so, she argues, saying: “We don’t expect them to do it on their own. They have a carer with them and the carers support the residents with the technology.
“The biggest hurdle is getting over that mindset that you have to be in the same room or be able to touch somebody [to have a consultation]. Actually, a lot of the consultations that take place in hospitals and between health and social care and between mental health and learning disability [professionals] are not physical examinations. They are face-to-face chats but that can happen through video and through a remote screen.”
Most GPs are known for being comfortable with IT and perhaps ahead of their hospital colleagues when it comes to collecting and using data, but they will also be expected to embrace ongoing technology development in the next few years.
In December 2015, the government’s mandate to NHS England said that by 2020, it wanted to see almost all (95%) of GPs offering the choice of an ‘e-consultation’ and other digital services to patients, while 95% of test results should be able to be digitally transferred between organisations.
Andrew Rankin, Associate at DAC Beachcroft, says: “There are issues related to sharing data across organisational boundaries and there are complexities associated with that, particularly if you are talking about NHS organisations being forced to share data across care pathways as is increasingly likely in the future. The information governance around that has to be properly resolved at an early stage of a project.
Dr Paul Cundy, a GP in Wimbledon and Chair of the joint IT committee of the British Medical Association (BMA) and the Royal College of General Practitioners (RCGP), says GPs have long been comfortable with technology.
“Virtually every GP will be doing most of their work electronically with no paper records. That’s the state of play in general practice at the moment. I haven’t written in a paper record for the past 20 years. That’s the way it should be,” he says.
However, the likelihood of most GPs offering e-consultations and other digital services to patients by 2020, as the government expects, depends on exactly what that means, he cautions.
“No matter how clearly you think you’ve typed something, a text message is open to misinterpretation so we don’t think that the concept of e-consultations via e-mail is either safe, possible or to be recommended,” he says.
“I would say an e-consultation, as a minimum, is voice exchange – a live human to human voice – and the obvious example is FaceTime or Skype. There’s no reason why that shouldn’t work and not only can you hear the person you are talking to, you can see them too.”
BMA GP Committee Deputy Chair Dr Richard Vautrey agrees that defining e-consultation is crucial.
“In many cases GPs are already promoting a whole variety of electronic opportunities for patients, whether that be ordering their prescriptions online or accessing their records or inputting information to their records. But we need to be careful not to assume that email-style consultations will be an easier and quicker way to deliver healthcare. In many cases, it could actually cause harm if done inappropriately.”
Technology is also helping many GPs to enjoy the benefits of fast transfer of patients’ medical records under the GP2GP transfer system.
Dr Cundy explains: “When you register with the majority of GPs now, they will get an electronic copy of the records from your past GP. This is a copy of every single record that the previous GP held, a copy of your entire lifeline. When you register, that information is there within a few hours. It’s a world beater and no one else on the planet has got anything like it.”
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